One of my favorite books is Extraordinary Popular Delusions and the Madness of Crowds, written in 1841 by Charles Mackay. It’s about the herd behavior of humans: fads and crazes and financial market follies. It covers witch trials, alchemy, superstitions. The book also covers the 17th Century “tulip bubble,” when flowers were currency, more valuable than gold. The lesson in the book is that once the populace gets convinced of something that turns out to be plain wrong or completely irrational, bad things happen. People die at the stake. Awakening to the realization that your tulip bulb investment is as worthless as a sack of onions is no picnic either.

There are signs that the world of mental health is in the midst of this sort of wake-up. The ruthlessness and greed implicit in the pharmaceutical industry’s marketing strategies is undermining the credibility of medication efficacy claims. The authority of the mental health’s secondary prevention model (early detection and treatment) and tertiary prevention model (treatment forever) is being confronted by research that shows better long-term outcomes on a whole-population basis when people do not use as much medication. The DSM is even becoming untethered from neuroscience.

I think the most significant development is that we now realize that people with mood problems, delusions and hallucinations deserve to be heard when they assert that what they experience has meaning. It means that writing people off is abusive and unethical. Someone with a mental health problem is not an irrational sub-human, but a valued person, no matter what he may be experiencing. We are also learning that social support is powerful on its own. It helps people with difficult symptoms stay on course.

As I see it, here is what we are waking up to.

Authority over madness is shifting to people with symptoms and away from experts and keepers. Despite symptoms a person may have, his life remains meaningful and valid. People can tolerate some level of chronic recurring symptoms and live safely, even flourish. People deserve opportunities to figure out what works and what is tolerable, and to choose an option that is presented accurately and supports their wishes. Nearly everyone wants normalcy anyway. Expertise is important, but should be advisory, not directive. Mental illness, practically speaking, is not that complicated. Ordinary people, friends and relatives and neighbors, are perfectly capable of supporting the people they care for. They are already doing it, in every nation and every culture on earth.

There are certainly some tough cases and more difficult situations, but even these require individualized approaches. We say we do that now, but if we have been applying bad theory, it’s time to face up to that, and reckon with society’s folly.